[Guidelines for uniform management of breath-holding spells]

Area of Science:

• Pediatrics
• Clinical Medicine
• Healthcare Management

Background:

• Breath-holding spells (BHS) are common in preschool children and cause significant healthcare resource consumption.
• Diagnosis of BHS has historically lacked standardized criteria, leading to variable clinical practice.
• Previous studies indicate potential overuse of diagnostic tests like ECGs and EEGs, and underuse of blood tests for contributing factors such as iron deficiency.

Purpose of the Study:

• To refine the definition and diagnostic criteria for BHS.
• To develop and evaluate a clinical management algorithm for BHS.
• To optimize healthcare resource allocation in the management of BHS.

Main Methods:

• Retrospective cohort analysis of 519 BHS cases (2004-2018) in Skåne.
• Refinement of BHS definition based on cohort data.
• Development of a clinical management algorithm and simulation for evaluating its impact.

Main Results:

• Analysis revealed overuse of electrocardiograms (ECGs) and electroencephalograms (EEGs), and underuse of blood tests for iron deficiency and anemia.
• Simulations demonstrated that the new algorithm could reduce EEG and ECG utilization.
• The proposed guideline is expected to increase the appropriate use of blood tests for treatable conditions.

Conclusions:

• Standardized diagnostic criteria and a clinical management algorithm can streamline BHS diagnosis.
• Implementation of the guideline can lead to more efficient allocation of healthcare resources.
• Targeted interventions, including appropriate blood testing, can improve BHS management and reduce healthcare costs.